Teleoperated surgical system with surgical instrument wear tracking

ABSTRACT

A surgical method is provided, comprising: providing an information structure in a computer readable storage device that associates an indication of surgeon skill level in at least one surgical activity performed using the surgical instrument with a surgical instrument actuator safety state of the surgical instrument for use during performance of the at least one surgical activity using the surgical instrument by a surgeon having the indicated skill level; tracking surgical instrument actuator state of a surgical instrument during performance of a surgical procedure by a surgeon; and transitioning the surgical instrument actuator state of the surgical instrument to the surgical instrument safety state during performance of the at least one surgical activity by the surgeon using the surgical instrument.

CLAIM OF PRIORITY

This application is a continuation of and claims the benefit of priorityunder 35 U.S.C. § 120 to U.S. patent application Ser. No. 16/349,208,filed on May 10, 2019, which is a U.S. National Stage Filing under 35U.S.C. 371 from International Application No. PCT/US2017/0061139, filedon Nov. 10, 2017, and published as WO 2018/089819 A1 on May 17, 2018,which claims the benefit of priority to U.S. Patent Application No.62/421,083, filed on Nov. 11, 2016, each of which is hereby incorporatedby reference herein in its entirety.

COPYRIGHT NOTICE

A portion of the disclosure of this patent document contains materialwhich is subject to copyright protection. The copyright owner has noobjection to the facsimile reproduction by any-one of the patentdocument or the patent disclosure, as it appears in the Patent andTrademark Office patent file or records, but otherwise reserves allcopyright rights whatsoever.

BACKGROUND 1. Field of Invention

Inventive aspects are associated with medical devices used duringsurgery. More specifically, aspects are associated with surgicalinstrument wear tracking.

2. Art

Surgeons typically undertake extensive study before performing asurgical procedure. Traditionally, surgeons were limited to the study ofgeneric anatomical models, such as photographs or drawings. Morerecently, various pre-operative diagnostic procedures (e.g., x-ray, CT,MRI, etc.) have made patient-specific anatomical information available.

In some cases, it is desirable to make additional, relevant anatomic andsurgical procedure information available to a surgeon. In one aspect, itis desirable to provide a surgeon planning an operation on a particularpatient with a surgical site video recording of an earlier surgicalprocedure performed on the particular patient. In another aspect, it isdesirable to provide a surgeon with one or more surgical videorecordings of surgical procedures on other patients that are similar tothe surgical procedure planned for a particular patient. In one aspect,it is desirable to provide such information to a surgeon prior to thesurgeon undertaking a particular surgical procedure. And in anotheraspect, it may be desirable to provide this information to a surgeonintraoperatively.

In one aspect, it is desirable to configure a video database thatincludes intraoperative surgical site video recordings of variousprocedures undergone by various patients. In one aspect, it is desirableto configure a medical device capable of video recording to furtherinclude an input that enables a surgeon using the medical device tohighlight and annotate the video recording in real time as it is beingrecorded. In one aspect, it is desirable to configure a computer-basedpattern matching algorithm to search through the individual records ofthe video database, identify relevant video records, and provide asurgeon with this relevant information for a particular surgicalprocedure.

SUMMARY

The following summary introduces certain aspects of the inventivesubject matter in order to provide a basic understanding. This summaryis not an extensive overview of the inventive subject matter, and it isnot intended to identify key or critical elements or to delineate thescope of the inventive subject matter. Although this summary containsinformation that is relevant to various aspects and embodiments of theinventive subject matter, its sole purpose is to present some aspectsand embodiments in a general form as a prelude to the more detaileddescription below.

A surgical method for use with a teleoperated surgical system thatincludes a surgical instrument and a surgical instrument actuator. Afirst information structure is provided in a computer readable storagedevice that associates a surgical instrument identifier with anindication of remaining useful lifetime of the identified surgicalinstrument. A second information structure is provided in a secondinformation structure in a computer readable storage device thatassociates a surgical instrument wear-down actuation state with asurgical instrument lifetime reduction amount. Surgical instrumentactuator state of the identified surgical instrument is tracked duringperformance of a surgical procedure. The indication in the firstinformation structure of remaining useful lifetime of the identifiedsurgical instrument is reduced by the surgical instrument lifetimereduction amount in the second information structure in response to thetracked surgical instrument actuator state matching the surgicalinstrument wear-down actuation state during the performance of thesurgical procedure.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a plan view of a minimally invasive teleoperated surgicalsystem.

FIG. 2 is a perspective view of a surgeon's console.

FIG. 3 is a perspective view of an electronics cart.

FIG. 4 is a diagrammatic illustration of a teleoperated surgical system.

FIG. 5 is a perspective view of a patient-side cart.

FIG. 6A is an elevation view of a surgical instrument.

FIG. 6B is an illustrative drawing representing an RFID tracking deviceassociated with an instrument in accordance with some embodiments.

FIG. 7 is a perspective view of an instrument manipulator.

FIG. 8 is a diagrammatic illustration of a surgical planning tool.

FIG. 9 is a flow diagram of a method of using a surgical planning tool.

FIG. 10 is an illustrative drawing representing storage atlas in acomputer readable storage device in accordance with some embodiments.

FIG. 11 is an illustrative drawing representing an example instance ofthe seventh information structure included within the atlas in thestorage device, which associates recorded video images from anindividual surgery with corresponding surgical instrument actuator stateinformation in accordance with some embodiments.

FIGS. 12A-12C are illustrative drawings showing an example surgicalinstrument and an actuator assembly in which the surgical instrument isshown in three different example operational states in accordance withsome embodiments.

FIG. 13 is an illustrative drawing representing an example instance ofthe eighth information structure of the atlas stored in the computerreadable storage device in accordance with some embodiments.

FIG. 14 is an illustrative flow diagram representing a process toconfigure processor to determine surgical instrument wear incurredduring a surgical procedure in accordance with some embodiments.

FIG. 15 is an illustrative drawing representing a sterilization chamberwith a surgical instrument disposed inside it in accordance with someembodiments.

DETAILED DESCRIPTION

This description and the accompanying drawings that illustrate inventiveaspects, embodiments, implementations, or applications should not betaken as limiting—the claims define the protected invention. Variousmechanical, compositional, structural, electrical, and operationalchanges may be made without departing from the scope of this descriptionand the claims. In some instances, well-known circuits, structures, ortechniques have not been shown or described in detail in order not toobscure the invention. Like numbers in two or more figures represent thesame or similar elements.

Elements described in detail with reference to one embodiment,implementation, or application may, whenever practical, be included inother embodiments, implementations, or applications in which they arenot specifically shown or described. For example, if an element isdescribed in detail with reference to one embodiment and is notdescribed with reference to a second embodiment, the element maynevertheless be claimed as included in the second embodiment. Thus, toavoid unnecessary repetition in the following description, one or moreelements shown and described in association with one embodiment,implementation, or application may be incorporated into otherembodiments, implementations, or aspects unless specifically describedotherwise, unless the one or more elements would make an embodiment orimplementation non-functional, or unless two or more of the elementsprovide conflicting functions.

Aspects of the invention are described primarily in terms of animplementation using a da Vinci® Surgical System (specifically, a ModelIS4000, marketed as the da Vinci® Xi™ HD™ Surgical System),commercialized by Intuitive Surgical, Inc. of Sunnyvale, Calif.

Knowledgeable persons will understand, however, that inventive aspectsdisclosed herein may be embodied and implemented in various ways,including robotic and, if applicable, non-robotic embodiments andimplementations. Implementations on da Vinci® Surgical Systems (e.g.,the Model IS4000 da Vinci® Xi™ Surgical System, the Model IS3000 daVinci Si® Surgical System) are merely exemplary and are not to beconsidered as limiting the scope of the inventive aspects disclosedherein.

In accordance with various aspects, the present disclosure describes asurgical planning tool that includes a medical device configured tovideo record the performance of surgical procedures. The videorecordings can be embedded with various metadata. e.g., highlights madeby a medical person. Additionally, the video recordings can be taggedwith various metadata, e.g., text annotations describing certain subjectmatter of the video, the identity of the patient to whom the videorecording corresponds, biographical or medical information about thepatient, and the like. In one aspect, tagged metadata is embedded in thevideo recordings.

In accordance with further aspects, the present disclosure describes ateleoperated medical device that includes a surgical instrument used toperform at least one surgical activity during a surgical procedure. Asurgical instrument typically has a limited useful lifetime during whichit can be reliably used to perform the surgical activity. In someembodiments, a lifetime is indicated as a count of a number of surgeriesin which it is permissible to use a surgical instrument. For example, aninstrument having a lifetime count of ten is permitted to be used in tenmore surgeries, Conversely, for example, an instrument having a lifetimecount of five is permitted to be used in five more surgeries.

Different surgical instruments are used to perform different surgicalactivities. For example, a scalpel is used for dissecting, a needle isused for suturing, and a heat source is used for cauterizing. The use ofa surgical instrument to perform its surgical activity during a surgicalprocedure imparts wear to the surgical instrument. Surgical instrumentwear accumulates so as to degrade the utility of the surgical instrumentover the course of several surgical procedures to a degree that it is nolonger reliably useful for its activity. For example, wear upon ascalpel can involve dulling of the scalpel cutting edges. A surgicalinstrument that is worn down a degree that it is no longer reliablyuseful typically is discarded or if feasible, refurbished. In accordancewith some embodiments, a record is maintained of remaining usefullifetime of a surgical instrument. Incremental wear imparted to thesurgical instrument during a surgical procedure is tracked. The recordof remaining useful lifetime of the surgical instrument is updated basedupon the incremental wear imparted during the surgical procedure.

In a teleoperated surgical system, different instruments may be used atdifferent stages of a surgical procedure. Moreover, the same instrumentmay be used in different actuator states at different stages of asurgical procedure. As used herein, the term actuator state refers to amechanical disposition of a surgical instrument as determined by anactuator, such as a motor, in response to input commands received from asurgeon or other surgical team member.

The video recordings and information structures that associate surgicalinstrument actuator states with surgical guidance or actuator safetystate information can be archived on an electronic medical recorddatabase implemented locally or on a cloud data storage service. Thevideo recordings can be made available to interested health careproviders. The information structures can be made available for use withthe teleoperated medical device to provide surgical guidance and tocontrol surgical instrument actuator state during performance of atleast one surgical activity during a surgical procedure.

Health care providers can search the medical device database based uponsurgeon skill level for videos and information structure relationshipsof interest using the metadata tags described above. Additionally, inone aspect, the surgical planning tool includes a computer-based patternmatching and analysis algorithm. In one aspect, the pattern-matchingalgorithm culls through the videos stored on the electronic medicalrecord database to identify correlations between visual characteristicsin the video recordings and associated metadata tags made by medicalpersons. The surgical planning tool can apply these correlations tonewly encountered anatomy, and thereby assist medical persons performinga procedure in making determinations about patient anatomy, preferredsurgical approaches, disease states, potential complications, etc.

In another aspect, a pattern matching algorithm culls through videosstored on the electronic medical record database to identifycorrelations between visual characteristics in the video recordings toidentify surgical activities that contribute to instrument degradation.Some routine surgical activities result in predictable rates ofinstrument degradation so that an instrument can be designated forefficacy and safety reasons as suitable for a fixed number of surgicaluses, referred to as “lifetimes”. For example, an instrument that has‘x’ number of lifetimes for its intended use is eligible for itsintended use in ‘x’ surgeries before it must be refurbished ordiscarded. Certain irregular surgical uses of an instrument canaccelerate its degradation. Surgical uses of individual instruments aretracked. A surgical planning tool can apply correlations betweensurgical activities and instrument wear-rate for to individual surgicalinstruments for inventory planning purposes to determine when to replaceor refurbish individual surgical instruments based upon their individualremaining lifetimes.

Minimally Invasive Teleoperated Surgical System

Referring now to the drawings, in which like reference numeralsrepresent like parts throughout the several views. FIG. 1 is a plan viewof a minimally invasive teleoperated surgical system 10, typically usedfor performing a minimally invasive diagnostic or surgical procedure ona patient 12 who is lying on an operating table 14. The system includesa surgeon's console 16 for use by a surgeon 18 during the procedure. Oneor more assistants 20 may also participate in the procedure. Theminimally invasive teleoperated surgical system 10 further includes apatient-side cart 22 and an electronics cart 24. The patient-side cart22 can manipulate at least one removably coupled surgical instrument 26through a minimally invasive incision in the body of the patient 12while the surgeon 18 views the surgical site through the surgeon'sconsole 16. An image of the surgical site can be obtained by anendoscope 28, such as a stereoscopic endoscope, which can be manipulatedby the patient-side cart 22 to orient the endoscope 28. Computerprocessors located on the electronics cart 24 can be used to process theimages of the surgical site for subsequent display to the surgeon 18through the surgeon's console 16. The number of surgical instruments 26used at one time will generally depend on the diagnostic or surgicalprocedure and the space constraints within the operating room amongother factors. If it is necessary to change one or more of the surgicalinstruments 26 being used during a procedure, an assistant 20 can removethe surgical instrument 26 from the patient-side cart 22, and replace itwith another surgical instrument 26 from a tray 30 in the operatingroom.

FIG. 2 is a perspective view of the surgeon's console 16. The surgeon'sconsole 16 includes a left eye display 32 and a right eye display 34 forpresenting the surgeon 18 with a coordinated stereoscopic view of thesurgical site that enables depth perception. The console 16 furtherincludes one or more control inputs 36. One or more surgical instrumentsinstalled for use on the patient-side cart 22 (shown in FIG. 1) move inresponse to surgeon 18's manipulation of the one or more control inputs36. The control inputs 36 can provide the same mechanical degrees offreedom as their associated surgical instruments 26 (shown in FIG. 1) toprovide the surgeon 18 with telepresence, or the perception that thecontrol inputs 36 are integral with the instruments 26 so that thesurgeon has a strong sense of directly controlling the instruments 26.To this end, position, force, and tactile feedback sensors (not shown)may be employed to transmit position, force, and tactile sensations fromthe surgical instruments 26 back to the surgeon's hands through thecontrol inputs 36.

The surgeon's console 16 is usually located in the same room as thepatient so that the surgeon can directly monitor the procedure, bephysically present if necessary, and speak to a patient-side assistantdirectly rather than over the telephone or other communication medium.But, the surgeon can be located in a different room, a completelydifferent building, or other remote location from the patient allowingfor remote surgical procedures.

FIG. 3 is a perspective view of the electronics cart 24. The electronicscart 24 can be coupled with the endoscope 28 and includes a computerprocessor to process captured images for subsequent display, such as toa surgeon on the surgeon's console, or on another suitable displaylocated locally and/or remotely. For example, if a stereoscopicendoscope is used, a computer processor on electronics cart 24 canprocess the captured images to present the surgeon with coordinatedstereo images of the surgical site. Such coordination can includealignment between the opposing images and can include adjusting thestereo working distance of the stereoscopic endoscope. As anotherexample, image processing can include the use of previously determinedcamera calibration parameters to compensate for imaging errors of theimage capture device, such as optical aberrations. Optionally, equipmentin electronics cart may be integrated into the surgeon's console or thepatient-side cart, or it may be distributed in various other locationsin the operating room.

FIG. 4 diagrammatically illustrates a teleoperated surgical system 50(such as the minimally invasive teleoperated surgical system 10 of FIG.1). A surgeon's console 52 (such as surgeon's console 16 in FIG. 1) canbe used by a surgeon to control a patient-side cart 54 (such aspatent-side cart 22 in FIG. 1) during a minimally invasive procedure.The patient-side cart 54 can use an imaging device, such as astereoscopic endoscope, to capture images of a surgical site and outputthe captured images to a computer processor located on an electronicscart 56 (such as the electronics cart 24 in FIG. 1). The computerprocessor typically includes one or more data processing boards purposedfor executing computer readable code stored in a non-volatile memorydevice of the computer processor. In one aspect, the computer processorcan process the captured images in a variety of ways prior to anysubsequent display. For example, the computer processor can overlay thecaptured images with a virtual control interface prior to displaying thecombined images to the surgeon via the surgeon's console 52.

Additionally or in the alternative, the captured images can undergoimage processing by a computer processor located outside of electronicscart 56. In one aspect, teleoperated surgical system 50 includes anoptional computer processor 58 (as indicated by dashed line) similar tothe computer processor located on electronics cart 56, and patient-sidecart 54 outputs the captured images to computer processor 58 for imageprocessing prior to display on the surgeon's console 52. In anotheraspect, captured images first undergo image processing by the computerprocessor on electronics cart 56 and then undergo additional imageprocessing by computer processor 58 prior to display on the surgeon'sconsole 52. Teleoperated surgical system 50 can include an optionaldisplay 60, as indicated by dashed line. Display 60 is coupled with thecomputer processor located on the electronics cart 56 and with computerprocessor 58, and captured images processed by these computer processorscan be displayed on display 60 in addition to being displayed on adisplay of the surgeon's console 52.

FIG. 5 is a perspective view of a patient-side cart 500 of a minimallyinvasive teleoperated surgical system, in accordance with embodiments ofthe present invention. The patient-side cart 500 includes one or moresupport assemblies 510. A surgical instrument manipulator 512 is mountedat the end of each support assembly 510. Additionally, each supportassembly 510 can optionally include one or more unpowered, lockablesetup joints that are used to position the attached surgical instrumentmanipulator 512 with reference to the patient for surgery. As depicted,the patient-side cart 500 rests on the floor. In other embodiments,operative portions of the patient-side cart can be mounted to a wall, tothe ceiling, to the operating table 526 that also supports the patient'sbody 522, or to other operating room equipment. Further, while thepatient-side cart 50) is shown as including four surgical instrumentmanipulators 512, more or fewer surgical instrument manipulators 512 maybe used.

A functional minimally invasive teleoperated surgical system willgenerally include a vision system portion that enables a user of theteleoperated surgical system to view the surgical site from outside thepatient's body 522. The vision system typically includes a camerainstrument 528 for capturing video images and one or more video displaysfor displaying the captured video images. In some surgical systemconfigurations, the camera instrument 528 includes optics that transferthe images from a distal end of the camera instrument 528 to one or moreimaging sensors (e.g., CCD or CMOS sensors) outside of the patient'sbody 522. Alternatively, the imaging sensor(s) can be positioned at thedistal end of the camera instrument 528, and the signals produced by thesensor(s) can be transmitted along a lead or wirelessly for processingand display on the one or more video displays. One example of a videodisplay is the stereoscopic display on the surgeon's console in surgicalsystems commercialized by Intuitive Surgical, Inc., Sunnyvale, Calif.

Referring to FIG. 5, mounted to each surgical instrument manipulator 512is a surgical instrument 520 that operates at a surgical site within thepatient's body 522. Each surgical instrument manipulator 512 can beprovided in a variety of forms that allow the associated surgicalinstrument to move with one or more mechanical degrees of freedom (e.g.,all six Cartesian degrees of freedom, five or fewer Cartesian degrees offreedom, etc.). Typically, mechanical or control constraints restricteach manipulator 512 to move its associated surgical instrument around acenter of motion on the instrument that stays stationary with referenceto the patient, and this center of motion is typically located at theposition where the instrument enters the body.

In one aspect, surgical instruments 520 are controlled throughcomputer-assisted teleoperation. A functional minimally invasiveteleoperated surgical system includes a control input that receivesinputs from a user of the teleoperated surgical system (e.g., a surgeonor other medical person). The control input is in communication with oneor more computer-controlled teleoperated actuators, such as one or moremotors to which surgical instrument 520 is coupled. In this manner, thesurgical instrument 520 moves in response to a medical person'smovements of the control input. In one aspect, one or more controlinputs are included in a surgeon's console such as surgeon's console 16shown at FIG. 2. A surgeon can manipulate control inputs 36 of surgeon'sconsole 16 to operate teleoperated actuators of patient-side cart 500.The forces generated by the teleoperated actuators are transferred viadrivetrain mechanisms, which transmit the forces from the teleoperatedactuators to the surgical instrument 520.

Referring to FIG. 5, in one aspect, a surgical instrument 520 and acannula 524 are removably coupled to manipulator 512, with the surgicalinstrument 520 inserted through the cannula 524. One or moreteleoperated actuators of the manipulator 512 move the surgicalinstrument 512 as a whole. The manipulator 512 further includes aninstrument carriage 530. The surgical instrument 520 is detachablyconnected to the instrument carriage 530. In one aspect, the instrumentcarriage 530 houses one or more teleoperated actuators inside thatprovide a number of controller motions that the surgical instrument 520translates into a variety of movements of an end effector on thesurgical instrument 520. Thus the teleoperated actuators in theinstrument carriage 530 move only one or more components of the surgicalinstrument 520 rather than the instrument as a whole. Inputs to controleither the instrument as a whole or the instrument's components are suchthat the input provided by a surgeon or other medical person to thecontrol input (a “master” command) is translated into a correspondingaction by the surgical instrument (a “slave” response).

In an alternate embodiment, instrument carriage 530 does not houseteleoperated actuators. Teleoperated actuators that enable the varietyof movements of the end effector of the surgical instrument 520 arehoused in a location remote from the instrument carriage 530, e.g.,elsewhere on patient-side cart 500. A cable-based force transmissionmechanism or the like is used to transfer the motions of each of theremotely located teleoperated actuators to a correspondinginstrument-interfacing actuator output located on instrument carriage530. In some embodiments, the surgical instrument 520 is mechanicallycoupled to a first actuator, which controls a first motion of thesurgical instrument such as longitudinal (z-axis) rotation. The surgicalinstrument 520 is mechanically coupled to a second actuator, whichcontrols second motion of the surgical instrument such astwo-dimensional (x, y) motion. The surgical instrument 520 ismechanically coupled to a third actuator, which controls third motion ofthe surgical instrument such as opening and closing or a jaws endeffector.

FIG. 6A is a side view of a surgical instrument 520, which includes adistal portion 650 and a proximal control mechanism 640 coupled by anelongate tube 610 having an elongate tube centerline axis 611. Thesurgical instrument 520 is configured to be inserted into a patient'sbody and is used to carry out surgical or diagnostic procedures. Thedistal portion 650 of the surgical instrument 520 can provide any of avariety of end effectors 654, such as the forceps shown, a needledriver, a cautery device, a cutting tool, an imaging device (e.g., anendoscope or ultrasound probe), or the like. The surgical end effector654 can include a functional mechanical degree of freedom, such as jawsthat open or close, or a knife that translates along a path. In theembodiment shown, the end effector 654 is coupled to the elongate tube610 by a wrist 652 that allows the end effector to be oriented relativeto the elongate tube centerline axis 611. Surgical instrument 520 canalso contain stored (e.g., on a semiconductor memory device 660associated with the instrument) information, which may be permanent ormay be updatable by a surgical system configured to operate the surgicalinstrument 520. In some embodiments, a semiconductor memory device 660associated with an instrument tracking device 662 is associated with theinstrument 520. In some embodiments, the instrument tracking device 662includes a radio frequency identification device (RFID) device.Accordingly, the surgical system may provide for either one-way ortwo-way information communication between the surgical instrument 520and one or more components of the surgical system.

FIG. 6B is an illustrative drawing representing an RFID tracking device662 associated with an instrument 520 in accordance with someembodiments. The RFID device 662 includes a storage device 660 thatincludes an information structure 664 that associates device identifierinformation 666 with remaining device lifetime information 668. The RFIDdevice 662 includes a transceiver circuitry 670 to send and receiveinformation wirelessly. The RFID device 662 includes control logiccircuitry 672 to control the storage device 660 and the transceiver 670.

FIG. 7 is a perspective view of surgical instrument manipulator 512.Instrument manipulator 512 is shown with no surgical instrumentinstalled. Instrument manipulator 512 includes an instrument carriage530 to which a surgical instrument (e.g., surgical instrument 520) canbe detachably connected. Instrument carriage 530 houses a plurality ofteleoperated actuators. In some embodiments, an RFID reader 535 isdisposed upon the instrument manipulator 512 in a location to read thecontents of the storage device 660 within an RFID device 662 associatedwith an instrument attached to the manipulator 512. Each teleoperatedactuator includes an actuator output 705. When a surgical instrument isinstalled onto instrument manipulator 512, one or more instrument inputs(not shown) of an instrument proximal control mechanism (e.g., proximalcontrol mechanism 640 at FIG. 6) are mechanically coupled withcorresponding actuator outputs 705. In one aspect, this mechanicalcoupling is direct, with actuator outputs 705 directly contactingcorresponding instrument inputs. In another aspect, this mechanicalcoupling occurs through an intermediate interface, such as a componentof a drape configured to provide a sterile barrier between theinstrument manipulator 512 an associated surgical instrument.

In one aspect, movement of one or more instrument inputs bycorresponding teleoperated actuators results in a movement of a surgicalinstrument mechanical degree of freedom. For example, in one aspect, thesurgical instrument installed on instrument manipulator 512 is surgicalinstrument 520, shown at FIG. 6. Referring to FIG. 6, in one aspect,movement of one or more instrument inputs of proximal control mechanism640 by corresponding teleoperated actuators rotates elongate tube 610(and the attached wrist 652 and end effector 654) relative to theproximal control mechanism 640 about elongate tube centerline axis 611.In another aspect, movement of one or more instrument inputs bycorresponding teleoperated actuators results in a movement of wrist 652,orienting the end effector 654 relative to the elongate tube centerlineaxis 611. In another aspect, movement of one or more instrument inputsby corresponding teleoperated actuators results in a movement of one ormore moveable elements of the end effector 654 (e.g., a jaw member, aknife member, etc.). Accordingly, various mechanical degrees of freedomof a surgical instrument installed onto an instrument manipulator 512can be moved by operation of the teleoperated actuators of instrumentcarriage 530.

Annotating a Recorded Video

FIG. 8 shows a schematic diagram of an exemplary surgical planning tool800. In one aspect, surgical planning tool 800 includes a teleoperatedsurgical system 850 in data communication with an electronic medicaldevice record database 830 and an instrument inventory management system860. Teleoperated surgical system 850 shown here is similar toteleoperated surgical system 850 shown at FIG. 4. In one aspect,electronic medical record database 830 includes the medical records ofpatients that have undergone treatment at a particular hospital.Database 830 and instrument inventory management system 860 can beimplemented on a server located on-site at the hospital. The medicalrecord entries contained in the database 830 and management system 860can be accessed from hospital computers through an intranet network.Alternatively, database 830 and management system 860 can be implementedon a remote server located off-site from the hospital, e.g., using oneof a number of cloud data storage services. In this case, medical recordentries of database 830 and management system 860 are stored on thecloud server, and can be accessed by a computer with internet access.

In one aspect, a surgical procedure is performed on a first patientusing teleoperated surgical system 850. An imaging device associatedwith teleoperated surgical system 850 captures images of the surgicalsite and displays the captured images as frames of a video on a displayof surgeon's console 52. In one aspect, a medical person at surgeon'sconsole 52 highlights or annotates certain patient anatomy shown in thedisplayed video using an input device of surgeon's console 52. Anexample of such an input device is control input 36 shown at FIG. 2,which is coupled to a cursor that operates in conjunction with a graphicuser interface overlaid onto the displayed video. The graphic userinterface can include a QWERTY keyboard, a pointing device such as amouse and an interactive screen display, a touch-screen display, orother means for data or text entry. Accordingly, the medical person canhighlight certain tissue of interest in the displayed image or enter atext annotation.

In one aspect, the surgical site video is additionally displayed on adisplay located on electronics cart 56. In one aspect, the display ofelectronics cart is a touch-screen user interface usable by a medicalperson to highlight and annotate certain portions of patient anatomyshown on an image that is displayed for viewing on the display on theelectronics cart. A user, by touching portions of patient anatomydisplayed on the touch-screen user interface, can highlight portions ofthe displayed image. Additionally, a graphic interface including aQWERTY keyboard can be overlaid on the displayed image. A user can usethe QWERTY keyboard to enter text annotations.

In one aspect, the surgical site video captured by the imaging deviceassociated with teleoperated surgical system 850 is recorded by theteleoperated surgical system 850, and stored on database 830, inaddition to being displayed in real time or near real time to a user.Highlights and/or annotations associated with the recorded video thatwere made by the user can also be stored on database 830. In one aspect,the highlights made by the user are embedded with the recorded videoprior to its storage on database 830. At a later time, the recordedvideo can be retrieved for viewing. In one aspect, a viewer of therecorded video can select whether the highlights are displayed orsuppressed from view. Similarly, annotations associated with therecorded video can also be stored on database 830. In one aspect, theannotations made by the user are used to tag the recorded video, and canbe used to provide as a means of identifying the subject mattercontained in the recorded video. For example, one annotation maydescribe conditions of a certain disease state. This annotation is usedto tag the recorded video. At a later time, a person desiring to viewrecorded procedures concerning this disease state can locate the videousing a key word search.

Retrieval of Stored Video

In some cases, it is desirable for a medical person to be able to viewvideo recordings of past surgical procedures performed on a givenpatient. In one aspect, a patient who previously underwent a firstsurgical procedure to treat a medical condition subsequently requires asecond surgical procedure to treat recurrence of the same medicalcondition or to treat anatomy located nearby to the surgical site of thefirst surgical procedure. In one aspect, the surgical site events of thefirst surgical procedure were captured in a surgical site videorecording, and the video recording was archived in database 830 as partof the patient's electronic medical records. Prior to performing thesecond surgical procedure on the patient, a medical person can perform asearch of database 830 to locate the video recording of the patient'searlier surgical procedure.

In some cases, it is desirable for a medical person planning to performa surgical procedure on a patient to be able to view video recordings ofsimilar surgical procedures performed on persons having certaincharacteristics similar to the patient. In one aspect, surgical sitevideo recordings of surgical procedures can be tagged with metadatainformation such as the patient's age, gender, body mass index, geneticinformation, type of procedure the patient underwent, etc., before eachvideo recording is archived in database 830. In one aspect, the metadatainformation used to tag a video recording is automatically retrievedfrom a patient's then-existing medical records, and then used to tag thevideo recording before the video recording is archived in database 830.Accordingly, prior to performing a medical procedure on a patient, amedical person can search database 830 for video recordings of similarprocedures performed on patients sharing certain characteristics incommon with the patient. For example, if the medical person is planningto use teleoperated surgical system 850 to perform a prostatectomy on a65 year-old male patient with an elevated body mass index using, themedical person can search database 830 for surgical site videorecordings of prostatectomies performed using teleoperated surgicalsystem 850 on other males of similar age and having similarly elevatedbody mass index.

In one aspect, a video recording of a surgical procedure is communicatedby database 830 to an optional personal computer 820 (as indicated bydashed line), and made available for viewing by a medical person whoplans to perform a surgical procedure. Additionally or in thealternative, the video recording of the earlier surgical procedure canbe communicated by database 830 to teleoperated surgical system 850, andmade available for viewing preoperatively or intraoperatively. In oneaspect, the video recording is displayed by teleoperated surgical system850 on a display located on surgeon's console 52. In another aspect, thevideo recording of the first surgical procedure is displayed on adisplay located on electronics cart 56.

Cloud-Based Video Database

In one aspect, database 830 is implemented on a remote server using acloud data storage service and is accessible by multiple health careproviders. Referring to FIG. 8, as shown by dashed line, surgicalplanning tool 800 optionally includes teleoperated surgical system 850(as indicated by dashed line) and personal computer 840 (as indicated bydashed line). In one aspect, teleoperated surgical system 850 is similarto teleoperated surgical system 850 and personal computer 840 is similarto personal computer 820, except that teleoperated surgical system 850and personal computer 820 are located at a first health care providerand teleoperated surgical system 850 and personal computer 840 arelocated at a second health care provider. In one aspect, a first patientrequires surgical treatment of a medical condition, and undergoes asurgical procedure using teleoperated surgical system 850 at the firsthealth care provider. A video recording of the surgical procedure isarchived on database 830. At a later time, a second patient requiressurgical treatment of the same medical condition, and plans to receivesurgical treatment using teleoperated surgical system 850 at the secondhealth care provider. Prior to performing the surgical procedure on thesecond patient, a medical person accesses database 830 through a secureinternet connection and searches database 830 for surgical site videorecordings of similar procedures. In one aspect, the medical persontreating the second patient is able to retrieve from database 830 thevideo recording of first patient's surgical procedure, without acquiringknowledge of the identity of the first patient. In this manner, theprivacy of the first patient is maintained. In one aspect, the videorecording of the first patient's surgical procedure includes highlightsand/or annotations made by the medical person who treated the firstpatient.

Computer Based Pattern Matching and Analysis

Surgical planning tool 800 can includes a pattern matching and analysisalgorithm implemented in the form of computer executable code. In oneaspect, the pattern matching and analysis algorithm is stored in anon-volatile memory device of surgical planning tool 800, and isconfigured to analyze the video recordings archived in database 830. Asdiscussed previously, each of the video recordings archived in database830 can be tagged and/or embedded with certain metadata information.This metadata information can include patient information such aspatient age, gender, and other information describing the patient'shealth or medical history. Additionally, as discussed previously, themetadata information can include highlights or annotations made by amedical person. In one aspect, these highlights and annotations areembedded with the video recording and archived together with the videoin database 830.

In one aspect, pattern matching and analysis algorithm includes an imageanalysis component that identifies patterns in shapes and colors thatare shared amongst multiple video recordings stored on database 830. Thepattern matching and analysis algorithm then reviews the tagged metadataassociated with this subset of video recordings to determine whether anywords or phrases are frequently associated with videos within thissubset. These analyses performed by pattern matching and analysisalgorithm can be used to assist medical persons in making determinationsabout patient anatomy, preferred surgical approaches, disease states,potential complications, etc.

A Method of Using a Surgical Planning Tool

FIG. 9 shows a method 900 of using a surgical planning tool. In oneaspect, the surgical planning tool is similar to surgical planning tool800 at FIG. 8. At 910, a fact or characteristic describing a medicalpatient, e.g., a medical condition suffered by a patient, is received bya medical device. Medical device can receive this fact or circumstancevia a user interface located on a teleoperated surgical system (e.g.,teleoperated surgical system 10 at FIG. 1 or teleoperated surgicalsystem 50 at FIG. 4), or alternatively, through a personal computersimilar to personal computer 820 at FIG. 2. At 920, the medical deviceuses the fact or characteristic received at 910 to retrieve at least onerelevant video recording of a surgical procedure from a medical devicedatabase. At 930, the medical device uses the video recordings todetermine surgical planning information. In one aspect, the surgicalplanning information includes the types of instruments used in therecorded procedure. At 940, the medical device displays to a user thesurgical planning information determined at 930.

A Method of Surgical Instrument Inventory Management Based uponObservation of Surgical Instrument Usage

Chart 1 identifies several example surgical instruments and thecorresponding incremental lifetime degradation resulting from routinein-surgery use, irregular in-surgical use, and sterilization inaccordance with some embodiments.

CHART 1 Lifetime Lifetime Total Total decrement - decrement - LifetimeLifetimes Lifetimes for per routine Per irregular decrement - Instrumentfor new refurbished in-surgery in-surgery Per Name instrument instrumentusage usage sterilization Suturing instr Scalpel instr Cauterizing instrScissors instr Other?

In some embodiments, an instrument can be refurbished to add lifetimesi.e. additional surgical uses. However a refurbished instrument maystart with fewer lifetimes than a new instrument. In some embodiments,the number of surgeries in which a surgical instrument can be usedvaries with the use of the instrument. Irregular use can result in morerapid degradation of the instrument. For example, an irregular use of ascissors instrument to perform suturing can result in accelerateddegradation. Moreover, a sterilization of an instrument can involve hightemperatures and chemical treatment, which can result in instrumentwear.

FIG. 10 is an illustrative drawing representing storage atlas in acomputer readable storage device 1004 in accordance with someembodiments. The storage atlas 1002 includes first informationstructures 1006 that indicate instances of previously performed surgicalprocedures. Second information structures 1008 associate surgicalprocedures with surgical activities performed and surgical instrumentsused during the surgical procedure. Third information structures 1010associate surgical activities with surgical instrument actuation states.Fourth information structures 1012 associate routine surgical instrumentuse, lifetime decrements with surgical instrument actuation states.Fifth information structures 1014 associate non-routine surgicalinstrument use, lifetime decrements with surgical instrument actuationstates. Sixth information structures 1016 associate surgical instrumentsterilization, lifetime decrements with sterilization events. Seventhinformation structures 1018 that associate video images of surgicalscenes recorded during surgical procedures with instrument actuationstates recorded during the surgical procedures. In some embodiments, thevarious information structures 1004-1018 are evaluated to produce eighthinformation structures 1020 that associate surgical activities withsurgical instrument activity states and with surgical instrumentlifetime decrements.

FIG. 11 is an illustrative drawing representing an example instance ofthe seventh information structure 1018 included within the atlas 1002 inthe storage device 1004, which associates recorded video images from anindividual surgery with corresponding surgical instrument actuator stateinformation in accordance with some embodiments. In one aspect, videoimages of patient anatomy structures and instruments used to operateupon those anatomical structures during a surgery and correspondingsurgical instrument actuator states are recorded and time stamped (t1,t2 . . . tn) during a surgery to produce a chronological record ofsurgical activities and corresponding surgical instrument actuatorstates during the surgical procedure. The time stamps are used totemporally align video images with surgical instrument actuator states.

During a surgery, a user may annotate the video recording and thesurgical instrument actuation state recording with metadata thatindicate corresponding surgical activity. The annotation may include oneor more of or a combination of written notes tagged to video informationand/or surgical instrument actuation state information, coloring orhighlighting (e.g., telestration) of images in the video recordings, forexample. The annotations may be time stamped for use to temporally alignthem with corresponding video recording information and correspondingrecorded surgical instrument state information.

During a teleoperated surgical procedure, a surgical activity can whichinvolves use of at least one surgical instrument. During the surgicalactivity, the surgical instrument is operated, under surgeon control, inone or more actuator states. Operation of the surgical instrument insupport of the surgical activity in the one or more surgical states canresult in degradation of the instrument's efficacy for its intended use.As explained more fully below, to keep track of this reduction inefficacy, a record indicating the instrument's remaining lifetime ismodified, e. g., a lifetime count may be decremented in response to theinstrument's usage in the surgical activity.

FIGS. 12A-12C are illustrative drawings showing an example surgicalinstrument 1202 and an actuator assembly 1203 in which the surgicalinstrument is shown in three different example operational states inaccordance with some embodiments. The example instrument 1202 includes ajaw end effector 1204 that can transition between open and closed statesand a continuum of partially opened/partially closed states in between.The example instrument 1202 also includes a two degree of freedom(2-dof) wrist 1206 that can move between different two-dimensional (x,y) positional states. The example actuator assembly 1203 includes afirst actuator 1208, which in some embodiments includes a jaw motor (JM)used to actuate the jaw end effector 1204. The example actuator assembly1203 includes a second actuator 1210, which in some embodiments includesa wrist motor (WM) used to actuate the wrist 1206. During a surgery, thesurgical instrument 1202 may transition through multiple actuationstates corresponding to different activities during a surgicalprocedure. As represented in FIG. 12A, for example, a surgical proceduremay involve a first surgical activity in which the first actuator 1208(the JM) disposes the jaw end effector 1204 to a fully open state andthe second actuator 1210 the (WM) disposes the wrist 1206 to a firstpositional state (x1, y1). As represented in FIG. 12B, for example, thesurgical procedure may involve a second surgical activity in which thefirst actuator 1208 transitions the jaw end effector 1204 to a fullyclosed state and the second actuator 1210 transitions the wrist 1206 toa second positional state (x2, y2). As represented in FIG. 12C, forexample, the surgical procedure may involve a third surgical activity inwhich the first actuator 1208 disposes the jaw end effector 1104 in apartially open/partially closed state and the second actuator 1210transitions the wrist 1206 to a third positional state (x3, y3).

FIG. 13 is an illustrative drawing representing an example instance 1020i of the eighth information structure 1020 of the atlas 1002 stored inthe computer readable storage device 1004 in accordance with someembodiments. The example eighth information structure instance 1020 iassociates surgical activities during a selected surgical procedure withsurgical instrument actuator states that are possible during theactivity. The example eighth information structure instance 1020 iassociates the possible surgical instrument actuator states withcorresponding surgical instrument lifetime decrements.

A first column of the example eighth information structure instance 1020i indicates a list of surgical activities, A1, A2, A3 . . . AN to beperformed during the example surgical procedure. A second column of theinformation structure instance 1020 i indicates instruments I1, I2, I3to be used during surgical activities. A third column indicates firstpossible surgical instrument actuation states that can occur duringcorresponding surgical activities. A fourth column indicates secondpossible surgical instrument actuation states that can occur duringcorresponding surgical activities. Referring to the third and fourthcolumns, the first instrument I1 can operate in either of two possiblesurgical instrument actuator (SIA) states, SIA₁₁ and SIA₁₂. The secondinstrument I2 can operate in only one surgical instrument actuatorstate, SIA₂₁. The third instrument I3 can operate in either of twopossible surgical instrument actuator states, SIA₃₁ and SIA₃₂. A fifthcolumn indicates lifetime decrements corresponding to correspondingfirst possible surgical instrument actuation states. A sixth columnindicates lifetime decrements corresponding to corresponding secondpossible surgical instrument actuation states. Referring to the fifthand sixth columns, the first instrument I1 operating in the firstinstrument's first actuator state SIA₁₁ is associated with the firstinstrument's first decrement count I1 _(C1), and the first instrument I1operating in the first instrument's second actuator state SIA₂₁ isassociated with the first instrument's second decrement count I1 _(C2).The second instrument I2 operating in the second instrument's firstactuator state SIA₂₁ is associated with the second instrument's firstdecrement count I2 _(C1), and the second instrument I2 operating in thesecond instrument's second actuator state SIA₂₂ is associated with thesecond instrument's second decrement count I2 _(C2). The thirdinstrument I3 operating in the third instrument's first actuator stateSIA₃₁ is associated with the third instrument's first decrement count I3_(C1), and the third instrument I3 operating in the third instrument'ssecond actuator state SIA₃₂ is associated with the third instrument'ssecond decrement count I3 _(C2).

It is noted that some surgical activities may involve use of aninstrument such as an endoscope, for example, which is not worn down ordegraded as result of its use. Also, some instruments such as instrumentI2, are operable in only in a single routine actuator state, and are notoperable in an alternative second actuator state, and therefore, isassociated with only a single category of lifetime decrement. Moreover,in some embodiments, a lifetime decrement associated with an instrumentactuator state is determined as a function of energy use over timeduring an instrument actuator state, and therefore the lifetimedecrement for such instrument can be variable depending upon energyusage. In accordance with some embodiments, the more energy is used, thelarger the lifetime decrement. For example, operation of an instrumentat higher speed during an actuator state can result in use more energythan operation of the same instrument in the same actuator state at alower speed.

Referring to the first row of the example information structure instance1020 i of FIG. 13, for example, during activity A1, the first instrumentI1 can be operated in the first instrument's first actuation stateSIA₁₁, which results in decrementing the first instrument's remaininglifetime 668 by the first decrement count I1 _(C1). Alternatively,during activity A1, the first instrument I1 can be operated in the firstinstrument's second actuation state SIA₁₂, which results in decrementingthe first instrument's remaining lifetime 668 by the second decrementcount I1 _(C2).

Referring to the second row of the example information structureinstance 1029 i of FIG. 13, for example, during the surgical, the firstactivity A2 of the surgery can involve the second instrument I2 operatedin the second instrument's first actuation state SIA₂₁, which results indecrementing the second instrument's remaining lifetime 668 by the firstdecrement count I2 _(C1). It is noted that there is no second instrumentsecond actuation state in this example. Referring to the Nth row of theexample information structure instance 1020 i of FIG. 13, for example,during the Nth activity AN, the third instrument I3 can be operated inthe third instrument's first actuation state SIA₃₁, which results indecrementing the third instrument's remaining lifetime 668 by the firstdecrement count I3 _(C1). Alternatively, during activity AN, the thirdinstrument I3 can be operated in the third instrument's second actuationstate SIA₃₂, which results in decrementing the third instrument'sremaining lifetime 668 by the second decrement count I3 _(C2).

FIG. 14 is an illustrative flow diagram representing a process 1402 toconfigure processor 58 to determine surgical instrument wear incurredduring a surgical procedure in accordance with some embodiments. Inblock 1404, a surgical instrument identification is received at an inputto a computer processing system associated with the electronics cart 56.The surgical instrument identification includes information to identifyeach individual instrument slated for use in a surgical procedure andcorresponding remaining lifetime information identified instruments. Inblock 1406, an identification of a surgical procedure is received at aninput of the computer processing system associated with the electronicscart 56. In block 1408, information included within the atlas 1002within information structures 1008, 1010, 1012, 1014 and 1016 is used toproduce an instance of the eighth information structure 1020 associatingsurgical activities with surgical instrument activity states and withsurgical instrument lifetime decrements.

During performance of the identified surgical procedure, block 1410tracks operational state of a surgical instrument actuator. In decisionblock 1412, a determination is made as to whether a current instrumentactuator state matches an actuator state that is associated with alifetime decrement for the instrument. In response to no match, controlloops back to block 1410 and tracking continues. In response to a match,block 1414 decrements the identified instrument's remaining lifetime 668based upon a lifetime decrement associated with the matching instrumentactuator state. Decision block 1416 determines whether the surgicalprocedure is done. In response to a determination that the surgicalprocedure is not yet done, control next flows back to block 1410, whichcontinues to track surgical instrument actuator state based upon otheridentified actuator state transition information, for example. Inresponse to a determination that the surgical procedure is done, block1418 uses the RFID reader 535 to read instrument identifier information666 and corresponding remaining lifetime information 668 from thestorage device 660 within the RFID 662 associated with the instrumentand sends remaining lifetime information for the identified instrumentto the inventory management system 860.

Assuming for example, that the process 1402 of FIG. 14 that the isperformed for using the example information structure instance 1020 i ofFIG. 13, during performance of the surgical procedure, block 1410 tracksoperational state of surgical instrument actuators for each ofinstruments I1, I2 and I3. In decision block 1412, a determination ismade as to whether a current instrument actuator state of any one ormore of the three surgical instrument actuators matches an actuatorstate that is associated with a lifetime decrement for the correspondinginstrument. In response to no match, control loops back to block 1410and tracking continues. In response to a match, block 1414 decrements anidentified instrument's remaining lifetime 668 based upon a lifetimedecrement associated with the matching instrument actuator state. Forexample, while tracking during surgical activity A1, the decision block1412 determines whether a current actuator state of instrument I1matches either of actuator state SIA11 or SAI21. In response to a matchbetween the actuator state of I1 and SIA₁₁, a lifetime 668 for I1 isdecremented by I1 _(C1). In response to a match between the actuatorstate of I1 and SIA₂₁, a lifetime 668 for I1 is decremented by I1 _(C2).Control next flows to decision block 1416, which determines whetherthere are additional surgical states to be performed. In this example,surgical states A2 through AN are to be performed after surgical stateA1. Accordingly, control flows back to block 1410, which continues totrack surgical instrument actuator state during surgical activities A2through AN based upon other identified actuator state transitioninformation, for example. Upon completion of all surgical activities A1through AN, block 1418 configures the processor to send an updatedlifetime information for the identified instrument to the inventorymanagement system 860.

FIG. 15 is an illustrative drawing representing a sterilization chamber1502 with a surgical instrument 520 disposed inside it in accordancewith some embodiments. The surgical instrument is associated with anRFID device 662 and a storage device 660. In operation, followingsterilization of an instrument prior to use of the instrument in a nextsurgery, the RFID reader 535 associated with the sterilization chamber1502 reads instrument identifier information 666 and correspondingremaining lifetime information 668 from memory 660 for transmission tothe inventory management system 860.

Although illustrative embodiments have been shown and described, a widerange of modification, change and substitution is contemplated in theforegoing disclosure and in some instances, some features of theembodiments may be employed without a corresponding use of otherfeatures. For example, in some embodiments, the processor 58 is coupledto a memory device such as storage device 1004 that includes aninstruction set executable on the processor 58 to cause the processor 58to perform operations. In some embodiments, the operations includeproviding in a first information structure in the memory device thatassociates a surgical instrument identifier with remaining usefullifetime of the identified surgical instrument. The operations furtherinclude tracking surgical instrument actuator state of the identifiedsurgical instrument during performance of a surgical procedure. Theoperations further include reducing the associated remaining usefullifetime of the identified surgical instrument by a surgical instrumentlifetime reduction amount in response to the tracked surgical instrumentactuator state matching a surgical instrument wear-down actuation stateduring the performance of the surgical procedure.

One of ordinary skill in the art would recognize many variations,alternatives, and modifications. Thus, the scope of the disclosureshould be limited only by the following claims, and it is appropriatethat the claims be construed broadly and in a manner consistent with thescope of the embodiments disclosed herein.

1. (canceled)
 2. A method for tracking use of a surgical instrument in asurgical system comprising: receiving first information indicating afirst activity of a surgical instrument; generating first usefullifetime reduction information based upon the first information;receiving second information indicating a second activity of thesurgical instrument; generating second useful lifetime reductioninformation based upon the second information.
 3. The method of claim 2,wherein the first lifetime reduction amount is different from the secondlifetime reduction amount.
 4. The method of claim 2 further including:sending an indication of a remaining lifetime of the instrument over anetwork to an inventory management system.
 5. The method of claim 2further including: sending an indication of the first remaining lifetimereduction information over a network to an inventory management system;and sending an indication of the second remaining lifetime reductioninformation over the network to an inventory management system.
 6. Themethod of claim 2 further including: causing adjusting of remaininglifetime information, stored in a computer readable storage,corresponding to the surgical instrument based upon the first usefullifetime reduction information; and causing adjusting of remaininglifetime information, stored in a computer readable storage,corresponding to the surgical instrument based upon the second usefullifetime reduction information.
 7. The method of claim 2 furtherincluding: causing adjusting of remaining lifetime information, storedin a computer readable storage device, corresponding to the surgicalinstrument based upon the first useful lifetime reduction information;and causing adjusting of remaining lifetime information, stored in thecomputer readable storage device, corresponding to the surgicalinstrument based upon the second useful lifetime reduction information.8. The method of claim 2 further including: causing adjusting ofremaining lifetime information, stored in a computer readable storagedevice, corresponding to the surgical instrument based upon the firstuseful lifetime reduction information; causing adjusting of remaininglifetime information, stored in the computer readable storage device,corresponding to the surgical instrument based upon the second usefullifetime reduction information sending an indication of the firstremaining lifetime reduction information over a network to an inventorymanagement system; and sending an indication of the second remaininglifetime reduction information over the network to the inventorymanagement system.
 9. A surgical system that includes a surgicalinstrument comprising: a processor; a memory device holding aninstruction set executable on the processor to cause the processor toperform operations comprising: receiving first information indicating afirst activity of a surgical instrument; generating first usefullifetime reduction information based upon the first information;receiving second information indicating a second activity of thesurgical instrument; generating second useful lifetime reductioninformation based upon the second information.
 10. The surgical systemof claim 9, wherein the first lifetime reduction amount is differentfrom the second lifetime reduction amount.
 11. The surgical system ofclaim 9, wherein the instructions to cause the processor to performoperations comprising: sending an indication of a remaining lifetime ofthe instrument over a network to an inventory management system.
 12. Thesurgical system of claim 9, wherein the instructions to cause theprocessor to perform operations comprising: sending an indication of thefirst remaining lifetime reduction information over a network to aninventory management system; and sending an indication of the secondremaining lifetime reduction information over the network to aninventory management system.
 13. The surgical system of claim 9, whereinthe instructions to cause the processor to perform operationscomprising: causing adjusting of remaining lifetime information, storedin a computer readable storage, corresponding to the surgical instrumentbased upon the first useful lifetime reduction information; and causingadjusting of remaining lifetime information, stored in a computerreadable storage, corresponding to the surgical instrument based uponthe second useful lifetime reduction information.
 14. The surgicalsystem of claim 9, wherein the instructions to cause the processor toperform operations comprising: causing adjusting of remaining lifetimeinformation, stored in a computer readable storage device, correspondingto the surgical instrument based upon the first useful lifetimereduction information; and causing adjusting of remaining lifetimeinformation, stored in the computer readable storage device,corresponding to the surgical instrument based upon the second usefullifetime reduction information.
 15. The surgical system of claim 9,wherein the instructions to cause the processor to perform operationscomprising: causing adjusting of remaining lifetime information, storedin a computer readable storage device, corresponding to the surgicalinstrument based upon the first useful lifetime reduction information;causing adjusting of remaining lifetime information, stored in thecomputer readable storage device, corresponding to the surgicalinstrument based upon the second useful lifetime reduction informationsending an indication of the first remaining lifetime reductioninformation over a network to an inventory management system; andsending an indication of the second remaining lifetime reductioninformation over the network to the inventory management system.